Depression during pregnancy - MyFOXChattanooga

By Lila Havens, Staff Writer, myOptumHealth

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Pregnancy is supposed to be a happy, exciting time. But instead of joyful, some pregnant women feel sad, stressed and hopeless.

As many as one in five women have depression during pregnancy, but it is often overlooked. It can be hard to untangle which symptoms are caused by pregnancy and which are caused by low mood. Also, some women don't seek help because they are ashamed to admit how they feel.

Depression during pregnancy poses serious risks for both mother and baby. Luckily, effective treatments are available. If you think you have depression, it's vital to seek help right away. This is especially important if you have had depression in the past.

Recognizing depression during pregnancy

A woman with depression will have some of the following symptoms for two weeks or longer:

• Persistent sad or "empty" feeling
• Loss of interest in activities she once enjoyed
• Feeling restless or irritable
• Change in appetite (eating more or less than usual)
• Sleeping too much or too little
• Trouble concentrating or making decisions
• Fatigue or low energy
• Feeling guilty, hopeless or worthless
• Thoughts of suicide or death (call 9-1-1 right away if you are thinking about harming yourself)

If you have any of these symptoms, tell your doctor right away. He or she may do tests to rule out other causes of symptoms. For example, anemia and low thyroid can cause some of these symptoms.

Your doctor may also ask questions to find out if you may be at risk for depression. You are at greater risk if you have ever had depression before (especially during or after a previous pregnancy) or if depression runs in your family. You may also be at greater risk for depression if you:

• Lack social support
• Have relationship problems
• Have a history of abuse
• Are living under stress
• Have a history of substance use or abuse
• Live alone
• Have mixed feelings about the pregnancy

Treating depression during pregnancy

Your doctor can help develop a plan to treat your depression. If your depression is severe, you may be referred to a psychiatrist for treatment.

Treatment options may include:

• Psychotherapy. Studies have shown that cognitive-behavioral therapy (CBT) or interpersonal psychotherapy can be effective for depression in pregnant women. Web- or computer-based CBT may be an option if you can't find a local therapist or if cost or transportation is an issue.
• Antidepressant medications. The medicines most often prescribed during pregnancy include selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft) and tricyclics such as amitriptyline (Elavil) and imipramine (Tofranil).
• Light therapy. The use of a special bright light can relieve symptoms in women who have a type of depression called seasonal affective disorder (SAD).
• Electroconvulsive therapy (ECT). ECT is a safe and effective option for women with severe depression that is life-threatening or isn't controlled by medication. There is little risk of harm to the mother or her baby from ECT with careful monitoring.

Antidepressants: are they safe during pregnancy?

Women are naturally concerned about whether it is safe to take antidepressants during pregnancy. The short answer is, experts aren't sure. Researchers don't test medications on women who are known to be pregnant because of possible harm to the developing fetus.

From what experts know, it appears that some antidepressants may slightly raise the risk of problems for the baby. These include congenital heart defects and high blood pressure in the lung arteries (pulmonary hypertension).

On the other hand, failing to adequately treat depression during pregnancy can also have serious consequences. Women who are depressed may not take good care of themselves, and they are at increased risk of problems such as high blood pressure during pregnancy, premature birth and low birth weight.

Are antidepressants are right for you? That's something you and your doctor will need to decide. Your doctor will consider your history of depression, if any, and how severe your depression is.

• Psychotherapy may be a good option for women with mild to moderate depression who don't want to take medication.
• The benefits of antidepressants may outweigh the risks for women with severe depression.

If you are currently taking an antidepressant, do not stop taking your medication without talking to your doctor. Your depression is likely to return if you suddenly quit taking your medication. Your doctor can help you decide if you should taper off your medication or keep taking it.

NOTE: Anyone being treated with antidepressants, especially people being treated for depression, should be watched closely for worsening depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed (either increased or decreased). Discuss any concerns with your doctor.

Other steps to a healthy pregnancy

In addition to following your treatment plan, there are other steps you can take to guard your and your baby's well-being:

• Get regular prenatal care so your doctor can monitor your health and spot problems early.
• Eat a healthy, varied diet, and take a daily prenatal vitamin that contains folic acid.
• Get some regular exercise. Your doctor can recommend a safe level of activity.
• Gain a healthy amount of weight.
• Don't smoke, drink or use drugs.
• Talk to your doctor before you take any medications, including over-the-counter drugs, herbs and supplements.

View the original Depression during pregnancy article on myOptumHealth.com 

SOURCES:

• Yonkers KA, Wisner KL, Stewart DE, et al. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. General Hospital Psychiatry. 2009;31(5):403-413. Accessed: 10/13/2009

• Marcus SM, Heringhausen JE. Depression in childbearing women: when depression complicates pregnancy. Primary Care. 2009;36(1):151-165. Accessed: 10/13/2009

• March of Dimes. Depression during pregnancy. Accessed: 10/13/2009

• Pedersen LH, Henriksen TB, Vestergaard M, Olsen J, Beck BH. Selective serotonin reuptake inhibitors in pregnancy and congenital malformations: population-based cohort study. British Medical Journal. 2009;339:b3569. Accessed: 10/13/2009